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How Much Have We Lost?

Tuesday, March 5, 2013

Weekly Column: New State Budget Brings Steps to Expand Medicaid

The following is my column that will appear in the Mt. Vernon Gazette, The Mt. Vernon Voice and Patch in the week of March 6, 2013.

New State Budget Brings Steps to Expand Medicaid

Last week, I wrote about the transportation legislation that
passed the General Assembly.The other major
policy change this session was the expansion of Medicaid.This was especially critical for the 44th
District.

Medicaid is a federal-state health insurance program for
low-income and disabled people. It is also the only provider of long-term
nursing care for many Americans, since Medicare coverage and coverage by most
private insurance policies is quite limited. Virginia has one of the most
restrictive Medicaid programs in the United States - you have to be very poor
to be eligible. Most rankings put Virginia at 48th in Medicaid
expenditures and 7th in per capita income. In other words, we are a
relatively wealthy state and we do not help the poor much.

The 44th District has the largest uninsured population
and the largest Medicaid population in Fairfax County.Over 9,000 children in our community receive
their healthcare from Medicaid.That is
equal to one in three children in the 44th District and 15% of all
residents of the 44th District.Approximately 70% of uninsured Virginians are employed and only 37% of
small businesses (less than 50 employees) provide employee health insurance
benefits.Approximately, 5.6% of the
uninsured or 56,000 people are Virginia veterans and their family members.

Virginia already spends millions indirectly on uninsured
care including about $100 million per year subsidizing uninsured care at state
hospitals, $515 million per year in charity care at hospitals, and about $300
million per year is provided at free clinics and through charities.Most analyses conclude that about 10% of
private health insurance cost is for uninsured individuals.

The Patient Protection and Affordable Care Act (AKA
Obamacare) allowed each state to expand Medicaid with the federal government
picking up between 90-100% of the cost over an eight-year period.The actual cost to Virginia taxpayers is
largely neutral due to the elimination of uninsured care, charity care, reduced
demand for free clinics, and uninsured care paid by private insurance.

The analyses prepared by Senate Finance staff also found that
the Virginia Medicaid expansion would create 33,000 Virginia jobs.Coverage for preventative care would also
reduce overall system expenditures as people will get help before they become
too sick.

Most states have agreed to expand Medicaid after analyzing
the consequences and rather than seeing their federal tax dollars go to other
states.Recently, even Republican Governors
Christie (NJ), Kasich (OH), and Rick Scott (FL) have moved forward.At the beginning of the session, Governor
McDonnell opposed expansion.In the last
few days of session, he moderated his position, but a large contingent of
downstate legislators continued to oppose the expansion.

The compromise struck on the last day created a panel of ten
Virginia legislators who are tasked with certifying that the federal government
has agreed to certain reforms – mainly the implementation of managed care in
the provision of services compensated by Medicaid.Upon the panel’s certification, the Governor
would be required to proceed with expansion.

Attorney General Cuccinelli issued an opinion that this
system is unconstitutional, but he issued the opinion without reading the
actual bill.This issue will be
litigated.

I voted for the final state budget largely due to the inclusion
of this language in the final amendments.I am hopeful that it will be sustained because it is absolutely critical
to getting our health insurance costs under control and providing economic
security to the working poor and other families in the 44th District.

Next week, I will
provide a third update on other measures in the state budget and other
legislation that passed this session.